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Cooperative partners
Programmatic Information Collection for the AHRQ Initiative to Support Primary Care to Advance Cardiovascular Health in States with High Prevalence of Preventable CVD Events
OMB: 0935-0259
IC ID: 244132
OMB.report
HHS/AHRQ
OMB 0935-0259
ICR 202010-0935-002
IC 244132
( )
Documents and Forms
Document Name
Document Type
Form 2
Cooperative partners
Form and Instruction
2 Attachment B: Cooperative Partners - Interview Protocol
Attachment B.DOCX
Form and Instruction
2 Attachment B: Cooperative Partners - Interview Protocol
Attachment B.DOCX
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Cooperative partners
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
2
Attachment B: Cooperative Partners - Interview Protocol
Attachment B.DOCX
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
24
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
60
0
60
0
0
0
Annual IC Time Burden (Hours)
60
0
60
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.